2021, Number 03
Intrauterine insemination versus in vitro fertilization in poor responders: a systematic review and meta-analysis
PDF size: 384.71 Kb.
ABSTRACTObjective: To determine whether in patients with low ovarian response the continuation of the in vitro fertilization procedure is associated with increased live birth rates versus conversion to intrauterine insemination.
Methodology: Systematic search of studies with reported live birth rates in major databases. Quality assessment of studies was done using the Newcastle-Ottawa Scale (NOS) score. Subgroup analysis by follicular response was performed.
Results: Twenty-eight citations were retrieved from which 18 were chosen and only 7 including data from 3398 patient-cycles (in vitro fertilization: 2115; IUI: 1283) were analyzed. The mean NOS quality score was 9 versus cycle conversion to intrauterine insemination. Women with low ovarian response to stimulation, during an in vitro fertilization cycle, who continued with oocyte retrieval and embryo transfer were more likely to have a live birth: 9.2% versus 3.7% (OR 3.15 (95%CI: 2.26-4.41)). In analysis by follicular response, in vitro fertilization was superior, except when a monofollicular response was observed: 3.6% with in vitro fertilization vs 2.7% (OR 1.02 (95%CI: 0.37-2.84)).
Conclusion: In patients with low ovarian response (≤ 4 follicles) during an in vitro fertilization cycle, persistence with in vitro fertilization is associated with higher odds of achieving a live birth versus conversion to intrauterine insemination, except in cycles with a monofollicular response, where conversion of the cycle to intrauterine insemination seems more judicious, since the odds of a live birth are similar and no surgical procedures or anesthesia are needed.
The European IVF-monitoring Consortium (EIM), for the European Society of Human Reproduction and Embryology (ESHRE), Calhaz-Jorge C, et al. Assisted reproductive technology in Europe, 2013: results generated from European registers by ESHRE†. Hum Reprod. 2017; 32 (10): 1957-73. doi.10.1093/humrep/dex264.
Veleva Z, Järvelä IY, Nuojua-Huttunen S, Martikainen H, Tapanainen JS. An initial low response predicts poor outcome in in vitro fertilization/intracytoplasmic sperm injection despite improved ovarian response in consecutive cycles. Fertil Steril. 2005; 83 (5): 1384-90. doi.10.1016/j. fertnstert.2004.11.056.
Committee on Standards for Systematic Reviews of Comparative Effectiveness Research, Board on Health Care Services, Institute of Medicine. Finding What Works in Health Care: Standards for Systematic Reviews. (Eden J, Levit L, Berg A, Morton S, eds.). National Academies Press; 2011: 13059. doi.10.17226/13059.
Reichman DE, Gunnala V, Meyer L, et al. In vitro fertilization versus conversion to intrauterine insemination in the setting of three or fewer follicles: how should patients proceed when follicular response falls short of expectation? Fertil Steril. 2013; 100 (1): 94-99. doi.10.1016/j. fertnstert.2013.02.049.